Dr. Dan Rahn became the fourth chancellor of the University of Arkansas for Medical Sciences on Nov. 1, 2009, replacing Dr. I. Dodd Wilson. Rahn previously was the president of the Medical College of Georgia and the senior vice chancellor for health and medical programs for the University System of Georgia. Rahn is a nationally recognized expert on Lyme disease and on workforce shortages in the health professions.
After earning his bachelor’s and medical degrees at Yale, Rahn completed his residency at Yale-New Haven Hospital and a postdoctoral fellowship in rheumatology at Yale.
Rahn retires as chancellor on July 31.
What would you like business executives in Arkansas to know about the ACA and proposed replacements? What would you want Arkansas’ congressional delegation to know?
The U.S. House of Representatives has already passed the American Health Care Act to replace the Affordable Care Act. The U.S. Senate is currently working on separate replacement legislation. The nonpartisan Congressional Budget Office has projected that the House version would increase the number of uninsured Americans by 23 million and the Senate version would increase the number by 22 million within the next decade. Both make significant cuts of hundreds of millions of dollars to the federal commitment to Medicaid. The combination of federal cuts and increased uninsured would wreak havoc with health insurance markets and the finances of hospitals and health systems.
Any new proposal to replace the ACA should include strategies to expand access to essential health care services (including preventive care), reward quality and efficiency, stabilize insurance markets and, through payment reform, provide incentives to reduce health care costs and avoidable health care expense. Both bills fall short when looked at through this lens.
Education and health are the foundations of economic development and are essential for a high quality of life. Health care equity should be a pillar of our society — an equal opportunity for a healthy life. These goals cannot be achieved without a stable health care system that promotes access to high-quality health care at an affordable cost for individuals and society at large. Cost-shifting and exclusion of vulnerable populations do not support these goals. Health reform proposals should lead toward equitable opportunities for a healthy life and predictable access to high-quality care for everyone in society while providing incentives for efficiency and savings overall.
Unless we agree on the goals in advance, we are unlikely to agree on strategies. Right now federal budget cost containment, even if it is at the expense of a well-functioning system and market, seems to be the driving force rather than improvement in the performance of our health system. This is faulty priority-setting.
Arkansas’ experience with health insurance expansion has been much more successful than the ACA overall due to engagement of all parties in system redesign and insurance expansion and should serve as a model for the nation.
Do you believe that the United States will eventually adopt a single-payer system?
At present there is a desperate need for a stable health insurance market in the U.S. The ACA and, in particular, Arkansas’ model for implementing health insurance expansion were steps in the right direction. The current congressional proposals are steps in the wrong direction. If anything will propel us toward a single-payer system, it is failure of the private insurance market, uncontrolled cost increases and increasing numbers of uninsured.
We need a national consensus regarding whether access to health care at the right time in the right location by the right provider is a right of citizenship and whether we are all in this together. If we agree on these principles, then a single-payer system should certainly be one of the options explored.
The administrative simplification for all participants would be significant, as would the associated cost savings. A key challenge to overcome, however, is how to maintain access, entrepreneurialism, excellence and innovation in a single-payer system.
What are the top three health care reforms you would like to see?
1. Universal coverage.
2. Payment redesign with pay for performance and movement toward health systems accepting increased amount of insurance risk.
3. Incentives for achievement of improved outcomes at the individual and community level to encourage innovation and team-based care.
4. Data and information transparency.
5. Stronger controls on pharmaceutical price gouging.
6. Broader adoption of care pathways and protocols based on best available evidence.
7. Investment in behavioral health and addiction, both research and care.
I have listed seven, but the top three are my top three.
What is your proudest professional achievement at UAMS?
I really can’t point to a “proudest” achievement. The chancellor does not achieve outcomes on his or her own. They occur through the collective efforts of many, many people working together to advance the mission of the institution on all fronts: education, care and research and discovery.
I am very proud of the excellent performance of our diverse academic programs. Last year, UAMS students had an overall 86 percent on-time graduation rate across all 70 programs with 930 graduates. I am proud of our increase in residency programs — totaling 66 with 800 residents. I am proud of the quality of our clinical programs and their growth — about 40 percent growth over the past eight years, and our initiatives in patient and family-centered care and transparency.
Research productivity in key areas to Arkansas — like addiction, aging, cancer, informatics, obesity, infectious diseases and bone disease — has been remarkable. At our Northwest Arkansas Regional Campus, we have launched new programs like our Physician Assistant and Physical Therapy programs and offer new services like our dental service and residency program.
I am proud of the 30 new endowed chairs and professorships that have been established. I am proud that we have grown the institutional resource base by $500 million annually — 50 percent growth — despite about a 5 percent reduction in state support over the eight-year period. This growth in revenue supports all component of UAMS’ mission.
I am proud of the partnerships we have formed with other Arkansas-based health systems.
How would you rate the job you did at UAMS? What areas at UAMS would you have liked more time to work on?
I think it is best to let others rate my performance. I do believe that there has been a good fit between my skills and the work at hand for UAMS. It is now time for my successor, who will again lead the institution to higher levels of performance and greater value for Arkansas.
There are many things I would have liked more time to work on. Life is too short. The next years are going to be challenging with disruptive changes coming from multiple directions. There are many things in flux, and I wish there was a greater sense of stability for the institution, but that is just not possible at present.
I wish that I had been able to secure more state funding for this great institution. The state appropriation is now 6 percent of our operating budget, and after using our academic appropriation to pay Medicaid costs, the state funding that is left is between 1 percent and 2 percent of our budget to support all academic programs, which means we are way too reliant on patient care funds to provide cross-support for core academic costs. This really has to change.
If you had to do it over again, would you enter medicine?
Yes, without any hesitation. At heart, I am a physician.
What’s the first thing you plan to do when you retire July 31?
Have to wait and see. I have no plans other than to reunite with our children and grandchildren and see what comes next.
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